Review
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Stem Cells. Jul 26, 2018; 10(7): 82-105
Published online Jul 26, 2018. doi: 10.4252/wjsc.v10.i7.82
Stem cell therapy for faecal incontinence: Current state and future perspectives
Jacobo Trébol, Ana Carabias-Orgaz, Mariano García-Arranz, Damián García-Olmo
Jacobo Trébol, General and Digestive Tract Surgery Department, Salamanca University Healthcare Centre, Salamanca 37007, Spain
Ana Carabias-Orgaz, Anaesthesiology Department, Complejo Asistencial de Ávila, Ávila 05004, Spain
Mariano García-Arranz, New Therapies Laboratory, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid 28040, Spain
Damián García-Olmo, General and Digestive Tract Surgery Department, Quiron-Salud Hospitals, Madrid 28040, Spain
Damián García-Olmo, Surgery Department, Universidad Autónoma, Madrid 28040, Spain
Author contributions: All authors equally contributed to this paper with drafting and critical revision; Trébol J performed literature review and analysis; Carabias-Orgaz A revised language editing; Trébol J and Carabias-Orgaz A wrote the paper; all authors reviewed the paper and gave their final approval of manuscript.
Conflict-of-interest statement: García-Olmo D is member of the Advisory Board of Tigenix S.A.U. and co-holds patent rights about biomaterial for suturing (P200402083-Spain, 04380271.9-Europe and 101573.55823US-United States). García-Olmo D and García-Arranz M co-hold patent rights for “Use of adipose tissue-derived stromal stem cells for treating fistula” (PL2944688 T3-Europe and US2006045872 A1-United States). Other authors indicated no potential conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jacobo Trébol, MD, PhD, Surgeon, Surgical Oncologist, General and Digestive Tract Surgery Department, Salamanca University Healthcare Centre, Paseo de San Vicente, No. 58-182, Salamanca 37007, Spain. jtrebol@saludcastillayleon.es
Telephone: +34-92-3291634
Received: May 22, 2018
Peer-review started: May 23, 2018
First decision: June 14, 2018
Revised: June 26, 2018
Accepted: June 30, 2018
Article in press: June 30, 2018
Published online: July 26, 2018
Processing time: 65 Days and 22.9 Hours
Abstract

Faecal continence is a complex function involving different organs and systems. Faecal incontinence is a common disorder with different pathogeneses, disabling consequences and high repercussions for quality of life. Current management modalities are not ideal, and the development of new treatments is needed. Since 2008, stem cell therapies have been validated, 36 publications have appeared (29 in preclinical models and seven in clinical settings), and six registered clinical trials are currently ongoing. Some publications have combined stem cells with bioengineering technologies. The aim of this review is to identify and summarise the existing published knowledge of stem cell utilization as a treatment for faecal incontinence. A narrative or descriptive review is presented. Preclinical studies have demonstrated that cellular therapy, mainly in the form of local injections of muscle-derived (muscle derived stem cells or myoblasts derived from them) or mesenchymal (bone-marrow- or adipose-derived) stem cells, is safe. Cellular therapy has also been shown to stimulate the repair of both acute and subacute anal sphincter injuries, and some encouraging functional results have been obtained. Stem cells combined with normal cells on bioengineered scaffolds have achieved the successful creation and implantation of intrinsically-innervated anal sphincter constructs. The clinical evidence, based on adipose-derived stem cells and myoblasts, is extremely limited yet has yielded some promising results, and appears to be safe. Further investigation in both animal models and clinical settings is necessary to drawing conclusions. Nevertheless, if the preliminary results are confirmed, stem cell therapy for faecal incontinence may well become a clinical reality in the near future.

Keywords: Faecal incontinence; Anal sphincter; Cell implantation; Tissue engineering; Cell therapy; Stem cells

Core tip: Faecal incontinence is very frequent and is associated with severe consequences for patients. Available treatment outcomes are not optimal, particularly in the long-term. Stem cells, with or without bioengineering, could improve these results, as demonstrated in other clinical settings. We present a descriptive review of the published literature about faecal incontinence and stem cells, and discuss the existing limitations and concerns. Preclinical studies have confirmed the feasibility and safety of stem cells, and show some interesting results; the limited clinical experience confirms the safety and potential efficacy. However, further studies are needed to obtain clear conclusions.